1. Influenza Vaccination Rates for Mass. Adults
MA BRFSS
*Preliminary data Jan -Sept
March 2003

2. Pneumococcal Vaccination Rates for Mass. Adults
MA BRFSS
*Preliminary data Jan -Sept
March 2003

3. Flu & PPV23 Vaccination Rates in Mass. LTC Facilities
MA DMA
March 2003

4. Flu and PPV23 Vaccination Rates - Medicare Beneficiaries
JAMA 2003;289:308
March 2003

5. State-Supplied PPV23 in Massachusetts
Available at no cost from MDPH for all residents at risk
Approx. 100,000 doses/year
March 2003

6. State-Supplied Flu Vaccine in Massachusetts
State-supplied flu vaccine approx. half of flu vaccine administered in state
568,000 doses for season
March 2003

7. State-Supplied Flu Vaccine in Massachusetts
Public sector – 52%
LHD – 29%
VNAs – 8%
CHCs – 7%
Private sector – 48%
Pedi – 10%
Int. med. – 10%
LTC – 10% (universal distribution)
March 2003

8. Funding for State-Supplied Vaccine for Adults
Funded through State Vaccine Account
Sustainability affected by:
Status of State budget
Rising costs of vaccine
Competition with newly-introduced vaccines
Flu ,000 doses
High ,000
,000
Pneumococcal started ,000 – 123,000
March 2003

9. Influenza Vaccine – Price* per Dose
*State contract price
March 2003

10. Doses of State-Supplied Flu & Pneumococcal – Mass.
Pneumo – 100,000 doses/year
March 2003

11. One Potential Solution:
Rev
Max!
March 2003

12. Medicare Reimbursement
Medicare reimburses for:
Cost of administration of vaccine, and
Cost of vaccine itself
March 2003

13. Medicare Reimbursement
Roster billing
Simplified billing process for mass immunizers
Rosters include names of Medicare B beneficiaries who were immunized
Rosters are attached to a CMS form and sent to Medicare for reimbursement
March 2003

14. Medicare Reimbursement
Roster billing: Who’s eligible?
Traditional Medicare providers
Physician, OPD, etc.
Nontraditional providers
Senior citizen’s center, pharmacy, Boards of Health, State Agencies, etc.
March 2003

15. Medicare Reimbursement in Mass.
38 MA towns roster bill for cost of administering state-supplied vaccine
59 towns have Medicare B provider number
State-wide Medicare workshops assist LHDs with application and billing process
March 2003

16. Medicare Reimbursement
Cost of administration of vaccine – 2003
Metro Boston: $9.41/dose
Rest of Boston: $8.60/dose
97% increase over 2002
March 2003

17. Medicare Reimbursement
Medicare reimbursement rate for the cost of the vaccine –
Flu: $8.02
Pneumo: $15.26
March 2003

18. Potential Revenue for Mass. 2002-03
Flu
PPV23
TOTAL
LHD
$ 1,019,000
$ 46,000
$ 1,065,000
LTC
$ 521,000
$ 52,000
573,000
$1,540,000
$98,000
$ 1,638,000
March 2003

19. Medicare Reimbursement Is State Eligible?
Medicare says Yes!
What next?
Center for Health Care Financing, UMass Medical School
Medicare
State PRO
March 2003

20. Medicare Reimbursement - Process
Complete Medicare application
Have administrators of state- supplied vaccine to submit copies of roster bills
Submit copies of roster bills to Medicare for cost of the vaccine
March 2003

21. Medicare Reimbursement Challenges
60+ page application
Getting vaccine administrators to enroll
Getting vaccine administrators to submit copies of their rosters to State
March 2003

22. Outcome in Massachusetts
Held up on a technicality
SSN# on application
Cuts to State Vaccine Budget
March 2003

23. However…
Medicare reimbursement for cost of state-supplied vaccine a viable option for generating revenue.
March 2003